exam 3
Which statement about chronic nonmalignant pain (CNP) is false? Anxiety and depression are common comorbid conditions. CNP often interferes with a person's work and personal life. It is rarely associated with autoimmune inflammatory conditions.
It is rarely associated with autoimmune inflammatory conditions.
Which of the following vaccines is contraindicated in HIV-infected adolescents and adults regardless of CD4 cell count? Pneumococcal vaccine Zostavax Human papillomavirus (HPV) Measles, mumps, and rubella (MMR) Live attenuated influenza vaccine (LAIV)
Live attenuated influenza vaccine (LAIV)
A patient reports a neck mass that has been present off and on for 5 or 6 weeks which varies in size. The provider palpates a lymph node measuring 1.25 cm. Which test will provide proper histologic diagnosis for this patient?
Lymph node biopsy
Which of the following is a serious consequence of polycystic ovarian syndrome (POCs)?
Metabolic syndrome
Above what dose of acetaminophen do you have to be cautious when administering opiate medications? 4,000 mg/day 4,000 mg/dose 2,000 mg/day 3,000 mg/day
4,000 mg/day
An adverse effect associated with chronic methadone therapy but not with other long-acting opiates includes:
A prolonged QT interval via electrocardiogram
Lifestyle modifications that may decrease risk of recurrence, manage treatment effects, and improve quality of life include:
All of the above
Models for cancer survivorship care include:
All of the above
Which are causes of epilepsy? Brain tumors Strokes Congenital malformations All of the above
All of the above
You are the primary care provider for an HIV-uninfected female who is trying to conceive with her HIV-infected male partner who is virally suppressed on ARV therapy. When discussing Truvada for PrEP you make sure to explain to your patient that: PrEP trials did not study the effects of PrEP on the developing fetus Truvada is Pregnancy Category B Truvada is recommended as a component of a HIV prevention strategy for serodiscordant couples trying to conceive All of the above
All of the above
You are the primary care provider for an HIV-uninfected female who is trying to conceive with her HIV-infected male partner who is virally suppressed on ARV therapy. When discussing Truvada for PrEP you make sure to explain to your patient that: PrEP trials did not study the effects of PrEP on the developing fetus Truvada is Pregnancy Category B Truvada is recommended as a component of a HIV prevention strategy for serodiscordant couples trying to conceive All of the above
All of the above
An example of healthcare maintenance guidelines that are different for MTF patients, as compared with cisgender female patients include:
All the above
A patient with Parkinson's disease (PD) has been taking carbidopa-levodopa (Sinemet) with good results, but develops increased dyskinesia. Which drug will be added to this patient's regimen to help control this symptom?
Amantadine
Which of the following behaviors carries the highest risk for HIV transmission? Oral sex Sharing sex toys Anal sex Biting Spitting
Anal sex
An 86-year-old female presents to the emergency department with acute onset of worsening confusion. She appears more agitated and anxious to caregivers. She has been physically aggressive with one caregiver and this is reported to be an abrupt change from her baseline mental status. This is most consistent with: Hypoactive delirium Hyperactive delirium Mixed delirium None of the above
Hyperactive delirium
A 43-year-old female presents to clinic requesting PEP following unprotected receptive vaginal intercourse with a man 48 hours prior. She does not know the HIV status of the man and cannot contact him. When you review the risks and benefits of initiating PEP for this potential exposure you include the following facts:
If the man was infected with HIV, her risk of acquiring the virus is 0.1%.
Which reason is false as to why long-acting opiates are preferred to short-acting opiates in chronic nonmalignant pain management? Long-acting opiates are easier than short-acting opiates to titrate up and down. Short-acting opiates tend to cause rebound pain and headaches. Short-acting medications have increased dependence and addiction potential. Due to longer half-life, long-acting opiates can be taken less frequently at lower doses.
Long-acting opiates are easier than short-acting opiates to titrate up and down.
A patient with cancer is expected to require long-term pain medication to manage cancer pain. Which agent will be best for this patient?
Morphine
A patient is diagnosed with rheumatoid arthritis after a review of systems, confirmatory lab tests, and synovial fluid analysis. Which of the following can the provide order initially to treat this patient? (Choose all that apply.)
Non-pharmacological treatments such as physical therapy Nonsteroidal anti-inflammatory drugs
What is the most important role of the primary care provider in cancer management?
Not 'referring' answer
A patient being treated for cancer has had chemotherapy within the past two weeks and comes to the primary care clinic with a fever of 38.5° C. What is the initial action?
Obtain a STAT CBC with differential
A patient with breast cancer has been symptom-free for 6 months and reports a new onset of lower back pain rated as an 8 on a 1 to 10 pain rating scale to the primary provider. What is most important when evaluating this patient's pain?
Obtaining an MRI of the spinal cord
A patient has recurrent lumbar pain with radicularopathy which is sometimes severe and limits function. The patient reports that prescription NSAIDs are no longer effective for pain relief. What will the provider recommend?
Order MRI and refer to an interventional spine physician
An HIV-infected patient returns in 72 hours to have a tuberculin skin test skin (TST) read. The skin test shows 5 mm of induration. What is the recommended management for this test result? Order an interferon gamma release assay (quantiferon) Order a CXR Repeat the TST Initiate treatment for latent MTB Document the TST reading as a false positive result
Order a CXR
If the SLR test suggests disc herniation in a patient with a new complaint of LBP, you should:
Order an MRI
A patient has swelling and tenderness in the small joints of both hands and reports several weeks of malaise and fatigue. A RF test is negative. What will the primary care provider do next?
Order radiographic tests, a CBC, and ANA, ACPA (Anti-Citrullinated Peptide Antibody)
A 43-year-old woman presents with a 12-month history of irregular menses, mostly infrequent menses followed by prolonged episodes of bleeding (up to 2 weeks). Her past medical, family, and social histories are noncontributory. Her review of systems is negative for hot flushes, weight changes, galactorrhea, headaches, changes in bowel movements, or skin problems. She is not sexually active. Her physical exam, including her pelvic exam, is normal. The bleeding pattern in this case is most likely due t
Ovulatory dysfunction
A patient is seen frequently over a 9-month period with somatic complaints that are not related to physical disease. The primary provider notes that the patient has had a 15% weight loss in the previous 2 months and the patient reports difficulty sleeping. The spouse tells the provider that the patient seems tired all the time and is irritable with other family members. What will the provider do initially?
Perform a suicide risk assessment
A 35-year-old woman without a previous history of dysmenorrhea reports lower pelvic pain and irregular bleeding between periods. What is the initial action in managing this patient?
Performing an abdominal, pelvic, and rectovaginal examination
A patient with gout and impaired renal function who uses urate-lowering therapy (ULT) is experiencing an acute gout flare involving one joint. What is the recommended treatment? Prednisone .5mg/kg/day PO X 5-10 days Discontinuing ULT while treating the flare Oral colchicine for 5 days Therapy with NSAIDs begun within 24 hours
Prednisone .5mg/kg/day PO X 5-10 days
A 28-year-old woman reports a 10-day history of vaginal spotting. Her past medical, family, and social histories are noncontributory. She is sexually active and uses condoms for contraception. Prior to this event, she had no complaints; her menses were regular before this episode. Which of the following laboratory tests is most important in her initial workup?
Pregnancy test
The following are all components of cancer survivorship as outlined in the Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Translation except:
Provision of palliative care
All trans patients considering hormone therapy should be referred to a mental health clinician before the initiation of hormones. tf
f
A patient is beginning treatment for chronic pain and is unable to tolerate nonsteroidal anti-inflammatory drugs. What will the provider prescribe for this patient? A mixed opiate product A pure opioid compound A referral for a nerve block procedure A selective serotonin reuptake inhibitor
not a ??
An oncology specialist recommends placement of radioactive isotopes in capsules near a patient's tumor. What is this form of radiation therapy called?
Brachytherapy
Severe leg weakness or sensory loss in lower extremities, urinary retention or incontinence and fecal incontinence, and anesthesia of the perineal area suggest (Choose all that apply.): Chose 2
Cauda equina syndrome Metastatic cancer to the spine
At what age do you begin Pap test screening?
Age 21 and continue every 3 years through age 29
Presbycusis is defined as
Age-related hearing loss
A 45-year-old patient has mild osteoarthritis in both knees and asks about non-pharmacologic therapies. What will the provider recommend?
Aerobic exercise
A post-menopausal female patient has a blood test that reveals mild hyperuricemia, although the patient has no symptoms of gout. What will the provider do?
Ask the patient about medications and medical history
What of the following diagnoses represent urgent ("red flag") causes of LBP?
Cauda equina syndrome Spinal cord compression Cancer
A 45-year-old female-to-male (FTM) patient who has had top surgery only (removal of female breast tissue; mastectomy) presents to your clinic for a general "check-up." What healthcare maintenance items might be important to discuss at this visit? Mammogram and fasting lipid panel BP check and prostate exam Cervical cancer screening and chest wall/axillary exam Vaccines and liver ultrasound
Cervical cancer screening and chest wall/axillary exam
A patient is on carbamazepine 600 mg BID and comes to you complaining of nausea, vomiting, headache, and fatigue. He is also having more seizures. What would you do?
Check carbamazepine levels and Check sodium levels
An 18-year-old woman presents with a 2-month history of intermenstrual bleeding, increased vaginal discharge, and mild lower abdominal pain. Her last menstrual period (LMP) was 1 week ago, and her cycles are regular. Sexual debut was 1 year ago; she is sexually active with the same partner (her only partner) and has taken oral contraception pills for 1 year. She reports taking her oral contraceptives consistently with no side effects. The most likely cause of this bleeding is
Chlamydia infection
What of the following are reasons to order a lumbar-sacral spine x-ray in patients with new LBP? (Choose all that apply.) Choose 3. Direct trauma to any part of lumbar-sacral area Chronic steroid use Prior diagnosis of cancer Evidence of sciatica on the Straight Leg Raise (SLR) test New fever, elevated sedimentation rate and white blood cell count
Chronic steroid use Direct trauma to any part of lumbar-sacral area Prior diagnosis of cancer
A patient who has chronic lower back pain reports increased difficulty sleeping unrelated to discomfort, along with a desire to quit working. What will the provider do? Consult with a social worker Ask the patient about addiction issues Increase the dosage of prescribed pain medications Order radiographic studies of the lower spine
Consult with a social worker
A homeless patient who has HIV infection has been on antiretroviral therapy (ART) for 18 months and has had normal CD4 counts and viral loads for past year. What will the provider recommend? Allow for periods of time off from ART medications Begin monitoring viral load and CD4 counts every 6 to 12 months Consider beginning highly active antiretroviral therapy (HAART) Continue monitoring viral load and CD4 counts every 3 to 4 months
Continue monitoring viral load and CD4 counts every 3 to 4 months
The baseline labs for a patient who is interested and eligible in PrEP contain the following results: hepatitis B surface antigen negative; hepatitis B surface antibody positive; hepatitis B core antibody positive. The patient reports never receiving the hepatitis B vaccine. Before initiating PrEP you should: Caution the patient that a hepatitis flare may occur if PrEP is discontinued Ensure that the patient completes the hepatitis B vaccination series Order a quantitative hepatitis B surface antibody Do nothing—the patient is immune to HBV
Do nothing—the patient is immune to HBV
Why is the fentanyl patch not appropriate for opiate-naive individuals? 10% of people do not metabolize this drug well, so they do feel effective relief. It can cause rebound pain due to a short half-life. It requires frequent and regular electrocardiogram monitoring. Due to a variable and long half-life, some individuals report difficulty with pain relief after 48 hours
Due to a variable and long half-life, some individuals report difficulty with pain relief after 48 hours
A 68-year-old man comes into your primary care clinic for a routine visit. He complains of increased difficulty reading the morning newspaper. He notes the problem has been occurring now for a few months and seems better when he borrows his wife's reading glasses. As a provider you should: Place an urgent referral to ophthalmology Diagnosis him with glaucoma and provide him with education regarding treatment Educate regarding presbycusis and notify him this is a normal process of aging Educate regarding presbyopia and notify him this is a normal process of aging
Educate regarding presbyopia and notify him this is a normal process of aging
A hospital worker who sustains a high-risk needlestick is 5 weeks pregnant. The ARV options at the hospital and surrounding pharmacies are limited. What fixed-dosed combination ARV tablet is a safe alternative in pregnancy and one that the patient could start taking immediately as PEP? Efavirenz/emtricitabine/tenofovir coformulated as Atripla Dolutegravir/abacavir/lamivudine coformulated as Triumeq Abacavir/zidovudine/lamivudine coformulated as Trizivir Emtricitabine/rilpivirine/tenofovir coformulated as Complera
Emtricitabine/rilpivirine/tenofovir coformulated as Complera
Which of the following cancers should be investigated in women with postmenopausal bleeding?
Endometrial
A 35-year-old woman has gone 120 days without a menstrual period. A pregnancy test is negative. What will the provider do, based on this symptom?
Evaluate for various causes of amenorrhea
A 29-year-old lawyer was recently diagnosed with focal seizures. Her provider prescribed lamotrigine and she has been tolerating it well at 150 mg BID. It has, so far, controlled her seizures; however, she is anxious that she may have another. She asks you what she can do to avoid seizures. Which is not a common seizure trigger?
Exercising
Inhaled corticosteroids (ICSs) are not indicated for use in COPD pharmacological management.
F
Children with ADHD seldom present with coexisting conditions such as oppositional defiant disorder, mood disorders, or anxiety disorders.
FALSE
The most common event that in turn causes loss of independence in older adults is: Frailty Delirium Falls Hearing loss
Falls
A positive SLR test always indicates disc herniation T/F
False
Once a person has been diagnosed with dementia, they can no longer reliably complete advance directives
False
Patients should be educated that it takes approximately 2 years to transition. However, increasing the dosage of hormones will hasten the transitioning process TF
False
Relief with standing or activity is more common with spinal stenosis.
False
Your patient's husband reports that during her 1-minute seizures, she wanders, smacks her lips, picks at her clothes, and loses awareness of her surroundings. What kind of seizure is she most likely having? Focal seizure with loss of consciousness (complex partial) Focal seizure without loss of consciousness (simple partial) Generalized tonic-clonic Absence
Focal seizure with loss of consciousness (complex partial)
A possible early sign of suspected Alzheimer's disease might include:
Getting lost or disoriented
A 45-year-old male presents to your clinic with complaints of severe sore throat, cervical lymphadenopathy, body rash, and subjective fever for 3 days. He reports sex with men, and his last unprotected anal sex encounter was 2 weeks ago with a man of unknown HIV status. His last HIV-negative screening was 6 months ago. Which HIV laboratory diagnostics should be ordered for this patient? HIV RNA viral load polymerase chain reaction (PCR) only. None, the patient has an obvious upper respiratory infection. HIV antibody/antigen test only. HIV antigen test only. HIV RNA viral load PCR and HIV antibody/antigen test.
HIV RNA viral load PCR and HIV antibody/antigen test.
This test indicates the patient's response to antiretroviral therapy (ART) and guides the selection of an ART regimen.
HIV-1 RNA (viral load)
A woman and her 6-year-old son present to your urgent care clinic after the boy sustains a bite on his forearm from another child on the school playground. The boy's skin was broken and he reports that the wound bled slightly after the bite. The boy denies any trauma to the biter's mouth prior to the bite and says the biter's saliva and teeth were not bloody. To address the mother's concern about HIV transmission you: Offer three-drug postexposure prophylaxis (PEP) for this exposure and reassure the patient and his mother that PEP is effective in preventing HIV transmission Offer two-drug PEP for this exposure and reassure the patient and his mother that this is a low-risk exposure Reassure the patient and his mother that this is a low-risk exposure but inform them that PEP is not recommended for persons under the age of 18 Reassure the patient and his mother that this was not a potential exposure to HIV and therefore PEP is not indicated
Reassure the patient and his mother that this was not a potential exposure to HIV and therefore PEP is not indicated
A 32-year-old female patient with no chronic medical problems initiates PrEP. You notice that her serum creatinine increases from 0.80 to 1.00 in her 3-month surveillance labs. Her CrCl dropped slightly but remains above 60 ml/min. The next most appropriate step to address this is: Reassure the patient that this increase can be transient and recheck kidney function in 1 to 3 months Reassure the patient that this increase can be transient and check for proteinuria today Have the patient stop taking PrEP and check for proteinuria today Have the patent stop taking PrEP and refer to nephrology
Reassure the patient that this increase can be transient and recheck kidney function in 1 to 3 months
Mr. T and his primary care provider have developed, agreed upon, and signed a chronic pain agreement. Mr. T. has a comprehensive pain management plan that includes the use of a long-acting opiate. A major agreement break would include: Missed appointments Refusal for a urine toxicology screen Seeking non narcotic medications from another prescriber None of the above
Refusal for a urine toxicology screen
Which laboratory tests may help distinguish systemic lupus erythematosus (SLE) from other systemic rheumatologic disorders? CRP C-reactive protein Rheumatoid factor Serum complement levels
Serum complement levels
In the male-to-female (MTF) trans patient on spironolactone alone, the following should be monitored periodically: Serum creatinine, potassium, sodium Liver function tests, lipid panel Complete blood count, TSH Vitamin D, Vitamin B12
Serum creatinine, potassium, sodium
Oxybutynin is commonly used as a pharmacologic treatment for UI. Contraindications include:
Severe kidney disease, glaucoma, and liver disease
Ms. D is a 40-year-old female, who has chronic low back pain, is being considered for chronic opioid therapy. You completed an opioid risk assessment. The assessment revealed that she has a brother and father with a history alcohol abuse. Based on this information, you would consider which of the following statements to be true: She is at very low risk for opioid-related aberrant behaviors. She is at moderate risk for opioid-related aberrant behaviors. She is at very high risk for opioid-related aberrant behaviors. None of the above statements are accurate, given her age and sex.
She is at moderate risk for opioid-related aberrant behaviors.
Ms. B has chronic hip pain due to osteoarthritis and recently has been taking up to six of her short-acting hydrocodone-acetaminophen tablets daily due to decreased time periods of pain relief with her regular regimen of four tablets per day. As a result, she runs out of her medication 5 days before her monthly refill. Which is the beststrategy to address her chronic pain? Physiologic dependence is common in chronic pain management and we should increase her total daily tablets to six hydrocodone-acetaminophen This is her first contract violation. Her pain meds should be tapered off. She should be cross-tapered to a long-acting opiate to decrease rebound pain. She should be referred to an opiate-addiction program because she is obviously displaying addictive behavior.
She should be cross-tapered to a long-acting opiate to decrease rebound pain.
A patient with chronic leg pain describes the pain as "stabbing" and "throbbing." This is characteristic of which type of pain? Neuropathic pain Referred pain Somatic pain Visceral pain
Somatic pain
Long-acting bronchodilator inhaler medications are safe to use in COPD.
T
More than 80% of episodes of low back pain (LBP) will recover spontaneously within 6 weeks. True/False
TRUE
A patient with cancer is reluctant to take an opioid agonist medication because of the side effects. What will the primary care provider recommend?
Taking a stool softener with the opioid
What is the purpose of radiation treatment prior to surgical resection of a tumor?
To debulk the tumor mass
If the SLR test suggests disc herniation in a patient with a new complaint of LBP, you should
Treat with a course of conservative care before further diagnostics
What is the preferred therapy to prevent a first episode of Pneumocystis pneumonia (PCP)? Clindamycin 300 mg TID atovaquone 1,500 mg daily Trimethoprim-sulfamethoxazole double strength(DS) 160/800 mg daily Aerosolized pentamidine 300 mg monthly
Trimethoprim-sulfamethoxazole double strength(DS) 160/800 mg daily
Which of the following is an absolute contraindication to hormone therapy?
Undiagnosed vaginal bleeding
A postmenopausal woman is diagnosed with lichen planus. After several weeks of treatment with a potent corticosteroid ointment, the woman reports improvement in itching, but states that she has extreme vaginal dryness. What will the provider recommend?
Using a topical estrogen cream along with the steroid
